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Biomedical subjects

J Kotzerke

Publications and source records attributed to J Kotzerke.

At least 91 records · Page 5Linked to original sources
PubMed1991

Emptying of the gastric substitute, glucagon-like peptide-1 (GLP-1), and reactive hypoglycemia after total gastrectomy.

Postprandial glucagon-like peptide-1 (GLP-1), pancreatic glucagon, and insulin were measured in 27 tumor-free patients 43 months (median) after total gastrectomy and in four controls using a 99technetium-labeled 100-g carbohydrate solid test meal. Emptying of the gastric substitute was measured by scintigraphy. Fourteen patients suffered from early dumping symptoms, and five of them also reported symptoms suggestive of reactive hypoglycemia (late dumping). The median emptying half-time (T1/2) of the gastric substitute was 480 sec. Sigstad's dumping score was 8.5 +/- 1.6 (mean +/- SE) in patients with rapid emptying (T1/2 less than 480 sec), and 3.0 +/- 1.5 in patients with slow emptying of the gastric substitute (P = 0.02). The peak postprandial concentration of GLP-1 was 44 +/- 20 pmol/liter in controls, 172 +/- 50 in patients without reactive hypoglycemia, and 502 +/- 116 in patients whose glucose fell below 3.8 mmol/liter during the second postprandial hour. Plasma GLP-1 concentrations peaked at 15 min, and insulin concentrations at 30 min after the end of the meal. A close correlation between integrated GLP-1 responses and integrated insulin responses (r = 0.68) was observed. Multiple regression revealed that three factors were significantly associated with the integrated glucose concentrations during the second hour (60-120 min): Early (first 30 min) integrated GLP-1 (inverse correlation; P = 0.006), age (P = 0.006), and early integrated pancreatic glucagon (P = 0.005). There was a close (inverse) relationship of T1/2 with early integrated GLP-1 and pancreatic glucagon, but not with insulin. Gel filtration of pooled postprandial plasma of gastrectomized individuals revealed that all glucagon-like immunoreactivity eluted at Kd 0.30 (Kd, coefficient of distribution), the elution position of glicentin. Almost all of the GLP-1 like immunoreactivity eluted at Kd 0.60, the elution position of gut GLP-1. The authors contend that GLP-1-induced insulin release and inhibition of pancreatic glucagon both contribute to the reactive hypoglycemia encountered in some patients following gastric surgery. Rapid emptying seems to be one causative factor for the exaggerated GLP-1 release in these subjects.

Blood Glucose↗
PubMed1991

Bronchial circulation after experimental lung transplantation: the effect of direct revascularization of a bronchial artery.

Direct revascularization of a bronchial artery has been proposed as a measure to alleviate the problem of bronchial ischemia after lung transplantation. To assess the effect of restoration of arterial blood flow to the transplanted bronchus, bronchial mucosal blood flow was measured in a model of modified unilateral lung transplantation in pigs. Laser Doppler velocimetry (LDV) and radioisotope studies using radio-labeled erythrocytes (RI) were used to measure blood flow at the donor main carina (DC) and upper lobe carina (DUC) after 3 h of reperfusion. The recipient carina was used as a reference point; values obtained by LDV and RI were expressed as percentage of blood flow at the recipient carina. Two groups of animals were studied. In group 1 (n = 6) standard unilateral transplantation was performed; in group 2 (n = 6) a left bronchial artery was reimplanted into the descending thoracic aorta of the recipient. No differences were observed between the two groups with respect to preoperative or postoperative gas exchange or hemodynamics. In group 1, bronchial blood flow at the DC was 37.6 +/- 2.2% (LDV) and 44.1 +/- 14.8% (RI) of reference blood flow. At the DUC, blood flow was 54.9 +/- 7.7% (LDV) and 61.6 +/- 25.7% (RI) of normal flow. In group 2, blood flow was increased at the DC as measured by LDV (55.3 +/- 17.1%; p less than 0.05) and by RI (60.8 +/- 25.3%; p less than 0.2). A similar increase was found at the DUC (LDV: 81.8 +/- 19.3%; p less than 0.05; RI: 88.6 +/- 31.0%; p less than 0.2). It is concluded that there is a significant gradient of blood flow from intra- to extrapulmonary airways after lung transplantation. Reimplantation of a bronchial artery results in significant improvement of graft bronchial blood flow. Restoration of bronchial perfusion to normal levels, however, cannot be achieved, suggesting a possible defect in the microcirculation of the donor airways.

Animals↗
PubMed1991

[Effect of reconstruction method on nutritional status after gastrectomy. Comparison of Roux-Y esophagojejunostomy and jejunum interposition].

Body composition, postprandial symptoms and social performance were studied in 61 tumor-free patients after total gastrectomy and Roux-Y esophagojejunostomy (n = 30) or jejunal interposition (n = 31). Emptying of the gastric substitute and small bowel transit of a 99mTc-labeled solid test meal were measured by scintigraphy. Serum glucose levels, and immunoreactive insulin were measured simultaneously. The lowest postoperative weight was 73 +/- 2% of the pre-morbid weight in Roux-Y cases, and 77 +/- 2% after jejunal interposition, the weight at study was 82 +/- 2% respectively 87 +/- 1% of the premorbid weight (p less than 0.05). Of the patients younger than 60 years at operation only one third of the twelve Roux-Y cases had resumed their work, as compared to two thirds of the eighteen interposition cases (p = 0.056). The incidences of the postprandial symptoms were not different among the modes of reconstruction, except for a slightly higher incidence of late dumping in Roux-Y (17% vs. 10%). After correction for gender higher mean values of fat-free mass, total body water, and intracellular water were measured in interposition cases (bioelectric impedance analysis). The emptying half-time of the gastric substitute was 488 s in the Roux-Y group, and 378 s after interposition (p = 0.05), whereas the small bowel transit (median: 200 min) showed no differences between the groups. There was no correlation between t1/2 or small bowel transit and the nutritional data. Early dumping (p = 0.01) was the only symptom significantly associated with rapid emptying of the gastric substitute.(ABSTRACT TRUNCATED AT 250 WORDS)

Anastomosis, Roux-en-Y↗
PubMed1991

[Unilateral lung transplantation in terminal pulmonary emphysema].

Early attempts of single lung transplantation for end-stage chronic obstructive pulmonary disease mostly failed due to a ventilation-perfusion mismatch between the allograft and the contralateral native lung. We performed unilateral lung transplantation in a 39-year-old female with severe pulmonary emphysema and could demonstrate in a one year follow-up that the transplanted lung will be given preference for both--ventilation and perfusion in approximately the same ratio (80%/90%). With improvement of pulmonary preservation, individual adjustment of immunosuppression and detailed monitoring of the transplanted lung unilateral lung transplantation becomes a therapeutical option in patients with severe emphysema.

Adult↗
PubMed1990

Extracellular space, blood volume, and the early dumping syndrome after total gastrectomy.

Extracellular space and blood volume were measured using 82Br dilution and 51Cr-tagged erythrocytes in 24 tumor-free patients after total gastrectomy. Eleven of the patients suffered from early dumping. Age, blood volume, and extracellular space were significantly smaller in dumpers (P less than 0.05). The dumping score could be predicted by a multiple regression model considering blood volume per lean body mass and extracellular space (r = 0.637; P = 0.0039). Rapid (t1/2 less than 360 seconds) emptying of the gastric substitute, assessed using a 99Tc-labeled solid test meal, was significantly associated with dumping in addition to extracellular space and blood volume (r = 0.876; P = 0.0018). Both rapid emptying and a narrow extracellular space seem to contribute to the early dumping syndrome.

Blood Volume↗
PubMed1990

Fat emulsions in parenteral nutrition after liver transplantation: The recovery of the allografts RES function and histological observations.

Following liver transplantation, the effect of post-operative parenteral nutrition with MCT LCT (Medium Chain Triglycerides/Long Chain Triglycerides) fat emulsions on the recovery of allografts RES function was investigated in a randomised prospective study of three groups of patients (group I, n = 14: 50g MCT LCT fats twice weekly, group II, n = 15: 0.7 g/kg body weight per day MCT LCT fats, group III, n = 17: 1.5 g/kg body weight per day MCT LCT fats). RES function was assessed using the (99m)Tc-HSA-MM-Clearance ((99m)Technitium-Human serum albumen-Millimicrosphere-Clearance). There were no statistically significant differences in the recovery of RES function between the groups. A negative effect on RES function as a result of the administration of MCT LCT fat emulsions up to 1.5 g/kg b.w. per day can therefore be excluded. The evaluation of liver biopsies before the administration of fats and at the end of TPN (Total Parenteral Nutrition) showed no evidence, in the 20 patients investigated, of any fatty changes in the liver caused by the infusion of fat.

Journal Article↗
PubMed1990

Renal elimination of beta-2-microglobulin and myoglobin in patients with normal and impaired renal function.

Since the demonstration that beta 2-microglobulin (beta 2M) is an amyloidogenic protein in man, the excretion of this low-molecular-weight protein under conditions with normal and reduced renal function has received increased interest. The renal arteriovenous extraction of beta 2M, polyfructosan (an inulin analogue), and a second low-molecular-weight protein, myoglobin, was measured in vivo in 16 human kidneys with normal renal function/gross morphology and in 22 kidneys with reduced function. In kidneys with normal function, the extraction of beta 2M significantly exceeded that of polyfructosan (0.198 +/- 0.037 vs. 0.182 +/- 0.05; p = 0.04), while that of myoglobin (0.177 +/- 0.068) was not different from that of polyfructosan. In kidneys with reduced function, the extraction of polyfructosan or myoglobin was not significantly altered. In contrast, the beta 2M extraction decreased to 0.110 +/- 0.060 (p less than 0.01 vs. extraction of polyfructosan or myoglobin). This decrease was significantly correlated with the decrease of the endogenous creatinine clearance or the total or unilateral 131I-hippuran clearance. These results indicate that in normal renal function the glomerular filtration of beta 2M may be supplemented by a peritubular mode of removal. The mechanism(s) underlying the selective decrease of beta 2M extraction in kidneys with reduced function remain speculative. However, this decrease will lead to a further augmentation of the retention of beta 2M in renal failure.

Female↗
PubMed1990

[Fat emulsions in parenteral feeding following liver transplantation. I. Effect on the recovery of RES function in the transplant].

Following liver transplantation, the effect of postoperative parenteral nutrition with MCT/LCT fatty emulsions on the recovery of RES function in the allograft was investigated in a randomised prospective study of three groups of patients (group I: 50 g MCT/LCT fats twice weekly, group II: 0.7 g/kg body weight per day MCT/LCT fats, group III: 1.5 g/kg body weight per day MCT/LCT fats). RES function was assessed using 99mTc-HSA-MM clearance. There were no statistically significant differences in the recovery of RES function after transplantation between the three groups. A negative effect on RES function as a result of the administration of MCT/LCT fats up to 1.5 g/kg body weight per day can therefore be excluded.

Fat Emulsions, Intravenous↗
PubMed1990

[A comparison of two algorithms for determining renal whole body clearance following simultaneous acquisition with a partially shielded whole-body counter and a gamma camera].

The influence of instrumentation, algorithm, and the time of blood sampling on whole-body renal clearance as defined by effective renal plasma flow (ERPF) was investigated. The study involved simultaneous sampling with a partially shielded whole-body counter (WBC) and a gamma camera to assess ERPF. The results obtained using two different analysis algorithms for each modality are compared. Although ERPF as determined by the Oberhausen technique was significantly higher than that obtained using an algorithm developed by the authors, for each algorithm there was no significant difference between the WBC and gamma camera-derived values within the range of 100 to 800 ml/min. Furthermore, positioning of the ROI was not critical for gamma camera-derived ERPF (SD less than 1% for multiple crescentic ROIs and approximately 4% for multiple rectangular ROIs). However, the time of blood sampling did appear more important since the average ERPF derived from the 10- and 20-min samples compared with that from the 15- and 25-min samples differed significantly for both analysis algorithms. The methodology which we have validated provides a more precise tool for further investigations of the influence of medication, posture, and exercise stress on renal function.

Algorithms↗
PubMed1990

Three-dimensional assessment of myocardial oxidative metabolism: a new approach for regional determination of PET-derived carbon-11-acetate kinetics.

We have developed a new analysis algorithm which generates polar coordinate maps of myocardial carbon-11-(11C) acetate kinetics. In 10 normal subjects (n = 20 studies), myocardial 11C clearance rate constants (k) averaged 0.057 +/- 0.009 (per minute). Regional k-values varied only 10.6 +/- 2.4% in the normal left ventricle. However, there was a small but significant segmental variation with increased 11C clearance in the septal, anterior, and basal regions (p less than 0.05). Since 11C clearance rates reflect tri-carboxylic acid cycle flux, these results suggest that myocardial oxidative metabolism is relatively homogeneous in the normal human heart at rest with minor regional variations, which possibly reflect varying regional wall stresses or substrate utilization. The proposed approach provides three-dimensional evaluation of regional oxidative metabolism which will permit characterization of the location, extent, and severity of myocardial disease.

Acetates↗
PubMed1989

Emptying of the gastric substitute after total gastrectomy. Jejunal interposition versus Roux-y esophagojejunostomy.

Emptying of the gastric substitute and small bowel transit time of a 99mTc-labeled solid test meal were measured in 20 tumor-free patients 13 to 63 (median, 35) months after total gastrectomy with Roux-y (n = 11) and jejunal interposition (n = 9) reconstruction. The emptying half-times ranged from 2 minutes to greater than 20 minutes. Rapid emptying was associated with dumping symptoms (p less than 0.03) and shorter orocoecal transit-time (p less than 0.05). Serum glucose concentrations rose more quickly in jejunal interposition, but the areas under the curve were identical in both groups. The median insulin-to-glucose ratio (areas under the curve) during the 20 minutes after the meal was 11.4 in jejunal interposition and 7.1 in Roux-y esophagojejunostomy (NS). Interposition cases had regained a significantly higher percentage (89%) of their premorbid weight than patients with Roux-y (78%; p less than 0.05). The weight/height2 ratio was above the 50th centile in 45% of interpositions, but below the 50th centile in all patients after the Roux-y mode of reconstruction (p less than 0.05). It is concluded that the emptying velocity of the gastric substitute has no impact on postoperative weight gain. The authors contend that the concept of a gastric substitute pouch is not supported by the findings of this study.

Anastomosis, Roux-en-Y↗
PubMed1989

A young woman with pituitary-tumor, Cushing's syndrome and medullary thyroid carcinoma--a rare case of MEN II?

A young woman presented with Cushing's syndrome. As a repeat surgical resection of a pituitary tumor did not cure her a bilateral adrenalectomy was performed, which resulted in symptomatic improvement of the patients condition. Several months later, a medullary carcinoma of the thyroid (MTC) was detected and resected. Retrospective analysis suggests that a paraneoplastic Cushing's syndrome may have been present in this patient. A connection of the pituitary tumor and the MTC could not be proved, a MEN-II-syndrome does not seem likely.

Adult↗
PubMed1989

Screening for pheochromocytoma in the MEN 2 syndrome.

Twenty-two patients with the multiple endocrine neoplasia type 2 (MEN 2) syndrome were screened for pheochromocytoma since it is a major cause of morbidity in MEN 2 families. Clinical symptoms, biochemical parameters, ultrasound, computed tomography or magnetic resonance imaging, and meta-iodo-benzylguanidine (MIBG) scintigraphy were evaluated for detection of adrenal tumors. Clinical symptoms and plasma or urine catecholamines appeared to be nonspecific, whereas MIBG scintigraphy was highly specific and the most sensitive parameter. Patients older than age 30 should be scintigraphically screened at least once despite the radiation exposure. Demonstration of only slight uptake is not an indication for surgery but rather for careful follow-up.

3-Iodobenzylguanidine↗
PubMed1989

[Surgery of benign liver tumors].

The most frequent benign liver tumors are hemangioma, focal nodular hyperplasia (FNH) and adenoma. It is essential for the diagnosis to differentiate these lesions from malignant tumors. While sonography, bolus-CT scan, chole-/bloodpool scintigraphy usually yield a safe diagnosis of hemangioma or FNH, adenomas do not show characteristic features. Operation is indicated for hemangioma of FNH only in case of tumor growth and/or symptoms. Operation for adenoma is as a rule indicated because of possible malignant transformation or uncertain differentiation from malignoma. Operative procedures include anatomical/atypical liver resection, ex situ resection or liver transplantation.

Adolescent↗